The perimenopause, menopause, and postmenopausal life stages arise with a variety of health concerns – primarily associated with diminished levels of sex hormones, including estrogen, progesterone, and testosterone. Although the acute signs and symptoms associated with menopause, including hot flashes, night sweats, irritability, brain fog, insomnia, mood swings . . .  and the list goes on, can be very uncomfortable and even debilitating, the increased risks for chronic health conditions is often overlooked because they are less evident – quieter.

It’s hard to ignore sweat dripping down your forehead, while increased blood pressure might go unnoticed. This blog is intended to shine some light on these less evident but potentially serious sequelae of menopause. To read more about contending with the more acute aspects of menopause you can check out these Take 5 Daily articles. The at-home Menopause Test can help you determine if you’re in menopause, and the nutrient/botanical formula Meta-Balance can help with the unpleasant symptoms associated with menopause.*

This article discusses four areas of your health and wellness to be extra mindful of during menopause.

1. Bone health

The health of your bones is probably the first long-term health concern that comes to mind when you think of menopause. Both osteopenia (characterized by low bone mineral density [BMD] that is not extreme enough to be called osteoporosis) and early-to-middle stages of osteoporosis are silent diseases because they have no outward symptoms. Thus, getting a bone density test can determine if you have signs of osteopenia or osteoporosis. Although testing is recommended for all women older than age 65, if you have an increased risk for diminished bone density, then it should be done earlier. Some factors that can increase your risk are:

  • Early menopause from a hysterectomy, breast cancer treatment, or other reason
  • An inactive lifestyle
  • Heavy use of alcohol, tobacco, caffeine, sugar, or carbonated beverages
  • Chronic health condition, such as diabetes, malabsorption, celiac disease, or hyperthyroidism
  • Being small-boned and consistently below normal weight for someone your size
  • Long-term use of certain prescription medications, such as steroids or anticonvulsants
  • A deficiency of certain key nutrients, including vitamins D and K and the minerals calcium and magnesium
  • Lack of sun exposure because you live in a northern latitude, you don’t get outdoors enough, or your skin is always covered when you’re outdoors
  • A family history of osteoporosis

In addition to monitoring your bone health, there are things you can do to support the health of your bones as you age. Although it’s never too early to start banking bone – best during childhood or adolescence – if you have not, then there is no time like the present to get started. You might not be able to add to your bone density but at least you can help prevent further loss.

Dietary factors. Although you could find a rationale for nearly every vitamin or mineral playing a role in bone health, the four stars are vitamins D and K and the minerals magnesium and calcium. And don’t forget the protein – half of your bone volume is made up of protein. Support your bone health with these foods:

  • Green leafy vegetables like kale, Bok choy, broccoli, and cabbage are sources of calcium, magnesium, and vitamin K1 (but avoid spinach as a calcium source because it’s high in oxalates that bind calcium).
  • If you aren’t a vegan or milk intolerant, then dairy products like milk, cheese, and yogurt are good sources of protein, calcium, vitamin K2, and vitamin D (most U.S. milk and all Canadian milk is fortified with vitamin D).
  • Fish, such as sardines with small, edible bones, are good sources of calcium; oily fish, especially wild-caught salmon, are good sources of vitamin D and omega-3 fatty acids (also important for bone health); and all fish provide good sources of protein.
  • Soy products are sources of calcium, magnesium, vitamin K2 (fermented soy), and protein.
  • Almonds and sesame seeds/sesame butter are good sources of calcium and magnesium.
  • Beans and other legumes are good sources of calcium, magnesium, and protein.
  • Avocadoes provide a good source of magnesium.
  • And last but definitely not least – dark chocolate is high in magnesium.

For added insurance, consider supplementing with bone-supportive nutrients.*

Exercise.  It’s well known that lack of exercise can contribute to bone loss – and loss of muscle mass too. There is no starker illustration of this than the case of astronauts on long space flights, where they can lose as much as 1-2 percent of their bone mineral density per month. And yes, while weightlessness certainly plays a part, your bones need to bear weight on Earth too – gravity isn’t enough. This is clearly illustrated by bone loss seen in bed-ridden or wheelchair-bound individuals. Weight-bearing exercises, key to improved bone health, are those that put mechanical stress on your bones, which in turn increases bone density. These include exercises like walking, jogging, dancing, using an elliptical, hiking, playing sports like pickleball, stair climbing, tai chi (the movements that are done standing up), and more.

In addition, strength-training exercises increase muscle mass. Because muscles are connected to bone, when they contract, they put stress on the bone, increasing bone density too. In addition, muscle strength helps prevent falls and subsequent fractures. Exercises in this category include lifting weights, weight machines, resistance bands, and exercises like squats.

In addition to exercise, a supplement like Thorne’s Amino Complex – branched chain and essential amino acids – can help support muscle mass.*

2. Cardio/metabolic health

Another sad reality of menopause is an increased risk for various cardiovascular and metabolic issues. For example, estrogen is involved in fat metabolism in the liver. So, when estrogen level drops, blood fats, including total cholesterol, LDL cholesterol, and triglycerides, can go up. And unfortunately, HDL – the “good cholesterol” – tends to go down. Decreased hormone levels also contribute to weight gain and increased blood pressure.

Dietary factors. Entire books have been written about diet for cardiovascular health. Many of the same dietary factors that support healthy bones also support heart and metabolic health. And the common denominator is a focus on veggies/fiber, fish, olive oil, and legumes – all included in the Mediterranean diet. Specific herbal teas can provide benefit as well; for example, hibiscus tea supports healthy blood pressure.

Bergamot is one of my favorite consumables for managing the chronic metabolic chaos associated with menopause. Bergamot is a yellow-green fruit the size of a small orange – a hybrid of bitter orange and lemon. You might be most familiar with bergamot as an ingredient in Earl Grey tea. The essential oil from the inner peel is mixed with tea leaves, providing Earl Grey tea’s unique floral, citrus aroma and flavor. But it’s the juice that has garnered attention in recent years because of its specific polyphenol content – plant constituents that act as antioxidants and benefit cardiovascular, metabolic, and liver health.*

Two recent studies found bergamot polyphenols are superior to placebo for their effects on fat metabolism, which in turn supports healthy cholesterol and triglyceride levels.*1,2 Additional studies show similar results in maintaining healthy lipid and blood sugar levels.*3-5 Bergamot can also benefit individuals working on weight management.* Bergamot extracts have been shown to decrease visceral fat (the fat stored around organs, especially after menopause) by supporting efficient fat metabolism.*Bergamot has also been shown in clinical trials to promote healthy liver function, clearance of fat from the liver, and a normal balance of liver enzymes.*

Thorne’s Metabolic Health combines a well-absorbed form of bergamot (as a phytosome) with curcumin phytosome for enhanced cardiometabolic benefits.*

Exercise. It’s likely no surprise to anyone reading this blog that exercise is essential for maintaining good cardiovascular health – it improves blood flow, reduces weight, improves sleep, decreases stress, and builds muscle mass to decrease blood sugar and improve insulin sensitivity.

Sleep. Sleep problems are common around menopause and can continue post menopause. But getting sufficient quality sleep each night is so important for maintenance of good cardiometabolic health, it should not be considered an afterthought. Poor sleep is linked to increased risk for high blood pressure and heart disease. And if you add sleep apnea to the mix, then your risk might be compounded.

Tips for maintaining good sleep hygiene:

  • Go to bed and get up about the same time each day.
  • Create a cool, dark sleep environment.
  • Avoid exposure to light from blue screens – TV, smartphone, tablet, etc. – for an hour or two before bed.

We’ve written a lot more about sleep at Take 5 Daily.

Stress. Chronic stress can harm your heart. It causes levels of the stress hormone cortisol to remain high, resulting in elevated blood pressure, blood sugar, and heart rate. Read more about what effect chronic stress has on your heart and how meditation can help. You can test your adrenal hormones – cortisol and DHEA – with Thorne’s Stress Test, which requires a simple at-home saliva collection.

3. Brain health

Although it isn’t recognized as often as some of the other chronic effects of menopause, brain fog, accompanied by forgetfulness and poor concentration, is also a common occurrence during menopause and can sometimes continue after menopause. Because there are actually estrogen receptors scattered throughout the brain, a decline in estrogen can impact memory and other cognitive functions.  

In addition to direct effects of estrogen on cognitive function, the weight gain that often accompanies menopause can affect your brain too. You might think of fat accumulation and weight gain as issues that mostly affect your heart and blood vessels, or also maybe your joints. But fat cells increase inflammation throughout your body, and that in turn can affect your brain. The inflammatory chemicals circulating in your body can cross the blood-brain barrier and negatively impact your brain in numerous ways. 

Diet. So, step one – focus on eating an anti-inflammatory diet. You guessed it, the Mediterranean diet – or a hybrid of the Mediterranean diet called the MIND diet – will benefit brain health too. It would be splitting hairs to draw a contrast between the two diets – the MIND diet focuses a little more on low fat and is less likely to include dairy products. Omega-3 fatty acids from fish oil are essential components of a brain health diet. They are found in high concentrations in the brain – especially DHA. Since easily metabolized omega-3 sources are limited to fatty fish, a DHA/EPA supplement is recommended. You can read more about DHA and brain health here and here.

Exercise. Exercise is essential for strong bones and a healthy heart, but it’s also essential for brain health. In addition to increasing oxygen to your brain, exercise increases a substance called brain-derived neurotrophic factor (BDNF). BDNF is important for our brains because it has been shown to increase new nerve cells and strengthen nerve connections in the brain. And, did you know regular exercise can actually decrease inflammation? The anti-inflammatory effect of regular exercise is partly associated with its effect on reducing body fat.

Sleep. Sleep is as or more important for brain health as it is for cardiovascular health. Believe it or not, your brain actually detoxifies when you are sleeping – a process that does not take place when you are awake. Poor sleep is related to poor memory, cognitive slowing, and even plaque buildup in the brain. 

In addition to developing good sleep hygiene (discussed above), a nutritional supplement might provide some benefit. The level of melatonin, a hormone essential for restful sleep, tends to drop as a woman ages. In addition to supporting a good night’s sleep, melatonin also supports bone health.*6 If you’re wondering about your own melatonin levels, you can find out with this easy, at-home Sleep Test.

4. Urinary tract/sexual health

Menopause is also characterized by urogenital changes. During menopause, reduced levels of the beneficial strains of Lactobacillus mirror the decreasing estrogen levels seen at this stage of a woman’s life. This can lead to the genitourinary syndrome of menopause – characterized by vaginal thinning and dryness, vulvovaginal pain, and increased risk for urinary tract infections.

Research supports the use of oral probiotics to help keep the vaginal microbiome in balance.* Several Lactobacillus species are the primary probiotics that have been studied for supporting a woman’s vaginal and urinary tract health.*7,8

Postmenopausal health prescription

As you can see, there is overlap across the major health concerns associated with menopause – both in terms of causes and potential solutions. To summarize: 

  • Consider an anti-inflammatory Mediterranean diet, with an added focus on bone-supportive foods and omega-3 fatty acids.
  • Exercise – both weight bearing and strength training. Work up to 30 minutes of weight-bearing exercise five days a week and strength training twice a week. And don’t forget the brain exercises. Reading a book, learning a new skill, playing word games – these can all help your brain stay healthy.
  • Stress reduction – engage in stress-reduction techniques – meditation, mindfulness, yoga – whatever works for you. This blog at Take 5 Daily describes three methods of mediation to consider: breathing, mantra meditation, and movement meditation.
  • A good night’s sleep – engage in good sleep hygiene as described above and consider a nutritional supplement, such as melatonin or a combination of melatonin and supportive botanical extracts.

Summary of Thorne’s nutritional supplements to consider:

  • Bone support supplements – Oscap or individual Vitamin D, and Vitamin K.*
  • Metabolic Health for cardiometabolic support.*
  • Advanced DHA – omega-3 DHA and EPA for brain health.* For additional brain support, consider Brain Factors, which contains whole coffee fruit extract, has been shown to increase BDNF,and improves reaction time in older adults.10*
  • Women’s Daily Probiotic for health of the vaginal and urinary tract.* Some of the Lactobacillus strains in this formula have added cardiovascular benefits of supporting healthy homocysteine and cholesterol levels.*11,12
  • Meta-Balance – not only supports a woman during the acute phase of menopause (hot flashes, night sweats, etc.) but Pycnogenol®, an ingredient in the product, provides benefit for vaginal dryness,13 skin elasticity,14 and promotes hair density15 in menopausal women.*
  • Collagen Plus, containing botanical extracts in addition to collagen peptides, offers additional support for skin elasticity, photo-aging, reduction of fine lines and wrinkles, and skin hydration.16-18

References

  1. Rondanelli M, Peroni G, Riva A, et al. Bergamot phytosome improved visceral fat and plasma lipid profiles in overweight and obese class I subjects . . . : A randomized placebo controlled trial. Phytother Res 2021;35(4):2045-2056. 
  2. Mollace V, Sacco I, Janda E, et al. Hypolipemic and hypoglycaemic activity of bergamot polyphenols: From animal models to human studies. Fitoterapia 2011;82(3):309-316. 
  3. Toth PP, Patti AM, Nikolic D, et al. Bergamot . . . A 6-month prospective study. Front Pharmacol 2016;6. 
  4. Gliozzi M, Maiuolo J, Oppedisano F, Mollace V. The effect of bergamot polyphenolic fraction . . . PharmaNutrition 2016;4:S27-S31. 
  5. Gliozzi M, Carresi C, Musolino V, et al. The effect of bergamot-derived polyphenolic fraction on LDL small dense particles . . . . Adv Biol Chem 2014;04(02):129-137.
  6. Yang K, Qiu X, Cao L, Qiu S. The role of melatonin in the development of postmenopausal osteoporosis. Front Pharmacol 2022;13:975181. doi: 10.3389/fphar.2022.975181. 
  7. Beerepoot MA, ter Riet G, Nys S, et al. Lactobacilli … in postmenopausal women. Arch Intern Med 2012;172(9):704-712. doi: 10.1001/archinternmed.2012.777.
  8. Petricevic L, Unger FM, Viernstein H, Kiss H. Randomized, double-blind, placebo-controlled study of oral Lactobacilli to improve the vaginal flora of postmenopausal women. Eur J Obstet Gynecol Reprod Biol 2008;141(1):54-7. doi: 10.1016/j.ejogrb.2008.06.003.
  9. Reyes-Izquierdo T, Nemzer B, Shu C, et al. Modulatory effect of coffee fruit extract on plasma levels of brain-derived neurotrophic factor in healthy subjects. Br J Nutr 2013;110(3):420-425.
  10. Robinson JL, Yanes JA, Reid MA, et al. Neurophysiological effects of whole coffee cherry extract in older adults…: a randomized, double-blind, placebo-controlled, cross-over pilot study. Antioxidants (Basel) 2021;10(2):144.
  11. Barreto FM, Colado-Simão AN, Morimoto HK, et al. Beneficial effects of Lactobacillus plantarum on glycemia and homocysteine levels in postmenopausal women with metabolic syndrome. Nutrition 2014;30(7-8):939-42. doi: 10.1016/j.nut.2013.12.004.
  12. Shimizu M, Hashiguchi M, Shiga T, et al. Meta-analysis: effects of probiotic supplementation on lipid profiles in normal to mildly hypercholesterolemic individuals. PLoS One 2015;10(10):e0139795. doi: 10.1371/journal.pone.0139795.
  13. Errichi S, Bottari A, Belcaro G, et al. Supplementation with Pycnogenol® improves signs and symptoms of menopausal transition. Panminerva Med 2011;53(3 Suppl 1):65-70.
  14. Marini A, Grether-Beck S, Jaenicke T, et al. Pycnogenol® effects on skin elasticity and hydration coincide with increased gene expressions of collagen type I and hyaluronic acid synthase in women. Skin Pharmacol Physiol 2012;25(2):86-92. doi: 10.1159/000335261. 
  15. Cai C, Zeng B, Lin L, et al. An oral French maritime pine bark extract improves hair density in menopausal women: A randomized, placebo-controlled, double blind intervention study. Health Sci Rep 2023;6(1):e1045. doi:10.1002/hsr2.1045
  16. Koikeda T, Tokudome Y, Okayasu M, et al. Effects of peach (Prunus persica)-derived glucosylceramide on the human skin. Curr Med Chem 2017;17(1):56-70. doi:10.2174/1871522217666170906155435
  17. Nanashima N, Horie K, Maeda H, et al. Blackcurrant anthocyanins increase the levels of collagen, elastin, and hyaluronic acid in human skin fibroblasts and ovariectomized rats. Nutrients 2018;10(4):495. doi: 10.3390/nu10040495.
  18. Hooper S, Hausenblas HA, Winters C. Efficacy of MitoHeal® supplementation on adult skin quality and patient satisfaction: a randomized, double-blind, placebo-controlled, pilot study. Clin Exp Dermatol 2022;47(12):2269-2272. doi: 10.1111/ced.15371.